Out-of-hospital cardiac arrest (OHCA) guidelines have traditionally focused on immediate clinical outcomes, such as return of spontaneous circulation and survival to discharge. However, the 2020 and 2025 International Liaison Committee on Resuscitation (ILCOR) recommendations formally introduced a Sixth Link dedicated to recovery, recognizing that the psychological burden experienced by lay rescuers is a critical determinant for the long-term effectiveness of emergency systems. Despite this evolution, a structured framework to mitigate the "informational void" and psychological distress in bystanders remains elusive. This systematic review aims to synthesize existing evidence on the emotional impact of resuscitation on lay responders—specifically focusing on post-traumatic stress disorder and moral injury—and to define the central role of emergency nurses in bridging the gap between the acute event and long-term recovery through the Lay Rescuer Support Model (LRSM). Following PRISMA guidelines, a systematic search will be conducted across PubMed, Scopus, and CINAHL, including randomized and non-randomized studies evaluating interventions aimed at supporting lay rescuers post-OHCA. The quality of evidence will be assessed using the Cochrane Risk of Bias tool and ROBINS-I, with the primary outcome being the reduction of psychological morbidity through structured nurse-led clinical handover and defusing protocols. Preliminary analysis suggests that lay responders frequently experience a "sense of abandonment" following the arrival of professional emergency medical services; therefore, the LRSM is proposed as a standardized nurse-led intervention designed to provide immediate emotional stabilization, factual feedback on the resuscitation effort, and a clear pathway for psychological follow-up. By effectively operationalizing the Sixth Link, this review identifies the emergency nurse as the pivotal figure in the chain of survival, transforming the "informational void" into a structured recovery process and providing the evidence base necessary to integrate the LRSM into international resuscitation protocols.
This study evaluates inter-observer variability in measuring internal jugular vein (IJV) ultrasonographic parameters using images obtained from medical ward patients. A cross-sectional study was conducted across 4 Italian hospitals. After brief training, 8 expert sonographers and 11 novices measured at the supraclavicular, cricoid, and submandibular levels, the anteroposterior expiratory maximum diameter (AP-IJV max), maximum cross-sectional area (CSA-IJV max), aspect ratio (AP-IJV max to latero-lateral diameter), and collapsibility index (IJV-c) on 60 IJV ultrasound images from 10 patients. Inter-observer reliability was assessed using the intraclass correlation coefficient. No significant differences were observed between experts and novices for AP-IJV max, CSA-IJV max, or aspect ratio across the different views. The lowest inter-examiner variability was found for AP-IJV max and CSA-IJV max at the supraclavicular level. Aspect ratio showed moderate reliability among experts but poor reproducibility among novices. The IJV-c demonstrated the highest inter-examiner variability in both groups. To our knowledge, this is the first multicenter study aimed at evaluating the method's reliability of different non-invasive acoustic measurements and windows to identify IJV dimensions better to use mainly in case of hypovolemia or fluid challenge. The AP-IJV max and the CSA-IJV max measurements showed excellent inter-observer reproducibility, suggesting the use of point-of-care ultrasound protocols for non-invasive volume assessment, particularly at the neck’s base or cricoid level.
Sudden cardiac death (SCD) in athletes remains a major clinical and public health concern, raising complex questions regarding the optimal balance between safety, sustainability, and equitable access to cardiovascular screening. Two contrasting paradigms are currently adopted worldwide: the mandatory and standardized Italian model and the voluntary, history-based approach predominantly used in the United States. The Italian system, which includes routine electrocardiography and exercise testing, has been associated with a marked reduction in SCD incidence but is burdened by high costs, false-positive findings, and organizational challenges. Conversely, the US model limits resource utilization but is associated with higher mortality rates and significant inequalities in access to preventive care. Using competitive basketball as a representative high-risk sport model, this narrative review summarizes the principal cardiac conditions associated with SCD. It discusses the strengths and limitations of existing screening strategies. We propose a hybrid, risk-based screening approach that integrates targeted diagnostic testing with continuous clinical surveillance, emergency preparedness, and structured education programs. Attention is given to the role of physiotherapists and allied health professionals as daily clinical observers within multidisciplinary teams. A multidimensional preventive strategy—combining selective screening, professional training, emergency action planning, and shared decision-making—may represent a sustainable and ethically sound model for further reducing SCD among athletes while preserving the right to sport.
Advances in medical care have increased both the age and clinical complexity of patients admitted to internal medicine wards, with multiple chronic conditions significantly impacting outcomes and treatment...
Multimorbidity represents one of the greatest challenges in modern healthcare. Advances in diagnostics and therapeutics have extended survival but also increased the number of patients presenting with multisystem conditions requiring coordinated inpatient management. This position paper from the EFIM Multimorbidity Working Group explores the evolution, current state, and future of hospitalist co-management models in the United States (US) and Europe. In the US, the emergence of hospitalists in the 1990s revolutionized inpatient medicine. Hospitalist-led co-management, defined as shared responsibility between internists and surgical or subspecialty team, has demonstrated consistent benefits, including reduced complications, shorter hospital stays, fewer readmissions, and enhanced patient and provider satisfaction. Success relies on clear role delineation, effective communication, and structured workflows. Evidence from surgical and oncological co-management highlights significant improvements in outcomes and efficiency, establishing hospitalist co-management as a key component of high-value care. In Europe, where internists traditionally provide comprehensive care, co-management has developed alongside integrated care models addressing multimorbidity. Different integrated and multidisciplinary programs exemplify person-centered frameworks, improving patient experience and quality of care. Although European evidence on co-management remains more limited, its expansion in surgical and medical fields illustrates growing recognition of its value. Yet challenges persist: defining accountability, managing workload, and ensuring cultural acceptance among specialties. The integration of digital health tools and artificial intelligence may further enhance its effectiveness, particularly for high-risk populations. At last, hospitalist co-management stands as a transformative model of inpatient medicine, linking efficiency with holistic, patient-centered care and shaping the future of multidisciplinary hospital practice.
The Milano-Cortina 2026 Winter Olympics represent a paradigmatic case of a widespread Olympics, with alpine and metropolitan clusters that transform medical services from a system centered on a single area into a multijurisdictional network. This narrative-comparative study analyzes the contemporary evolution of Olympic health management models (2006-2026) and contextualizes the Milano-Cortina plan through a literature review and documentary analysis of official reports from past editions, bid dossiers, and International Olympic Committee strategic documents. The results show a transition from host-city models to host-region arrangements, with a progressive increase in governance requirements, standardization, and informational interoperability. In the Milano-Cortina case, the multi-cluster architecture, the dualism between closed-loop pathways and care for the general population, and the integration with emergency care and public health further increase organizational complexity. Consistent with Winter Games surveillance showing sport-specific injury variability and a non-negligible illness burden, internal medicine—alongside emergency care—emerges as a stabilizing component for non-traumatic conditions and comorbidities. The model's effectiveness will depend on centralized oversight, interregional coordination, and monitoring mechanisms to ensure continuity of care and territorial equity.
Despite notable progress in the representation of women in medicine globally, significant gender gaps in salary and career advancement persist. In 2014, women accounted for 41.2% of doctors across Organisation for Economic Co-operation and Development (OECD) countries, with Italy (40.3%) aligning closely with this average. While Italian Ministry of Health data show that female representation in the National Healthcare System has further increased to approximately 69% by 2021, professional progression remains asymmetrical. The primary endpoint of this study was to examine gender-based inequities in leadership roles and career trajectories within Italian internal medicine. In 2024, we conducted a nationwide survey among hospital internists affiliated with the FADOI (Italian Scientific Society of Internal Medicine). Data were collected via an online platform with a 20% response rate. We analyzed the distribution of senior clinical and managerial positions, controlling for observed professional characteristics and demographics. Our findings confirm a significant "glass ceiling" effect. Despite their predominance in the workforce, women occupy only 26.8% of general management and chief of medicine positions. Furthermore, women remain markedly underrepresented in the leadership of complex healthcare structures (37.4% female vs. 62.6% male). These vertical disparities are accompanied by horizontal inequalities, including a persistent gender pay gap and structural barriers related to work-life integration and organizational culture. Although the trend points toward greater gender participation in the workforce, this has not yet translated into equitable representation in top-tier positions. The results underscore the necessity for targeted institutional reforms to dismantle the systemic barriers hindering women's career progression in internal medicine.
Telemedicine has expanded since the COVID-19 pandemic, underscoring the need to equip future healthcare workers with digital health competencies. This cross-sectional study at Gulf Medical University, Ajman, UAE, evaluated telemedicine readiness among 1000 health profession students across nine academic programs (response rate 76.9%). Only 14.9% reported familiarity with telemedicine and 19.8% felt confident in its use, while 42.5% reported no familiarity and 33.5% lacked confidence. Although 74% engaged in self-directed learning, only 25% had received formal telemedicine education. Formally trained students were significantly more likely to pursue self-training (p=0.0125) and demonstrated higher confidence (p<0.001). In multivariable ordinal regression, self-directed training [adjusted odds ratio (aOR) 5.93, 95% confidence interval (CI) 3.10-11.33] and formal education (aOR 3.26, 95% CI 1.78-5.97) independently predicted higher familiarity and confidence, whereas program affiliation did not. Clinical-year students reported lower confidence than pre-clinical peers (aOR 0.57, 95% CI 0.33-0.97). Formal education was the sole independent predictor of believing telemedicine would improve clinical skills (aOR 2.64, 95% CI 1.30-5.36). Most students (70.2%) supported curriculum integration. Readiness gaps are driven by training exposure rather than program affiliation, highlighting the need for a structured, longitudinal, university-wide telemedicine curriculum.
Introduction and Aim. Type 2 diabetes mellitus (T2DM) is associated with early structural and functional cardiac alterations. Some long non-coding RNAs (lncRNAs) are markers of cardiac damage in diabetic cardiomyopathy; data in prediabetics remain unknown. This study aimed to evaluate the expression of lncRNAs related to myocardial fibrosis, epicardial adipose tissue (EAT) accumulation, and heart failure (HF) risk in subjects with prediabetes or newly diagnosed T2DM and to explore correlations with clinical and echocardiographic parameters. Materials and Methods. Thirty-three subjects with prediabetes or newly diagnosed T2DM, asymptomatic for HF, were enrolled. All participants underwent clinical evaluation, blood sampling, and transthoracic echocardiography. lncRNA expression was measured by real-time PCR using actin as a reference gene. The analyzed lncRNAs were CCDC68-2: 1, ARL4C-2: 3, RNF145-1: 1, NOS2P3, and MALAT1. Results. Subjects were divided according to median NT-proBNP levels into Group 1 (n=16, <75 pg/mL) and Group 2 (n=17, ≥75 pg/mL). BMI did not differ between groups. Group 2 showed higher C-reactive protein levels, greater prevalence of E/A ratio <0.7, and increased EAT thickness (all p=0.05). No differences were observed in indexed left atrial volume, E/A ratio, or isovolumic relaxation time. Expression of CCDC68-2: 1, ARL4C-2: 3, RNF145-1: 1, and MALAT1 was significantly higher in Group 2. Conclusions. lncRNAs, combined with laboratory and echocardiographic parameters, may enable very early identification of individuals at increased risk of diabetic cardiomyopathy.
Background. In people with type 2 diabetes mellitus, glucagon-like peptide-1 receptor agonists and sodium–glucose cotransporter 2 inhibitors provide cardio-renal benefits, but the additive effect of their combination on renal outcomes in clinical practice is less defined. Materials and Methods. Observational study (312 patients) with a baseline assessment and follow-up at 24 months. We compared semaglutide, empagliflozin, and combined semaglutide plus empagliflozin therapy. Primary endpoint: composite renal responder (non-negative change in estimated glomerular filtration rate, eGFR, and no worsening in albuminuria category). Analyses used adjusted models and inverse probability of treatment weighting. Results. The renal responder rate differed across groups (empagliflozin 52.9%, semaglutide 73.2%, combination 97.1%; global p <0.00001). In adjusted models, the combination outperformed empagliflozin (odds ratio 33.55; p <0.00001) and semaglutide (odds ratio 13.99; p=0.0004), with consistent findings after weighting (global p=0.0007). The combination also improved change in eGFR (β 11.17; p=0.0055). The triglyceride–glucose body mass index (TyG-BMI) showed no significant between-group differences after adjustment (global p=0.4719). Conclusions. In this real-world cohort, combined semaglutide plus empagliflozin therapy was associated with better renal outcomes than either monotherapy, with robust results after adjustment and weighting.
Introduction. Metabolic dysfunction–associated steatotic liver disease (MASLD) is an increasing global burden, particularly in patients with type 2 diabetes mellitus (T2D). Data from sub-Saharan Africa remain scarce. This study assessed the prevalence of MASLD and associated risk factors among patients with T2D receiving care at a rural hospital in northern Uganda. Materials and Methods. A cross-sectional study was conducted from August 2024 to April 2025 among 176 patients with diabetes. Sociodemographic, clinical, biochemical, and lifestyle data were collected, and hepatic steatosis was assessed by abdominal ultrasound. Univariate, multivariate, and principal component analyses were performed. Results. The prevalence of steatotic liver disease was 25.9% among patients with type 2 diabetes, with the majority of cases being of pure metabolic origin (~75%). Female sex was associated with significantly lower odds of severe MASLD, whereas obesity, greater waist circumference, higher total cholesterol levels, and metformin use were associated with increased odds of severe disease. Conclusions. In this rural-low-resource setting, the prevalence of MASLD among patients with T2D was lower than expected, but the pattern of associated risk factors closely resembled those observed in westernized populations. Metformin use acts as a marker of metabolic severity rather than a causal factor in a context with limited antidiabetic options. Findings emphasize the necessity of early prevention campaigns even in low-resource settings.
Introduction. Multidrug-resistant (MDR) bacterial infections are an emerging threat in older patients, but the role of global frailty, beyond age and comorbidity, has not been fully clarified. Materials and Methods. We conducted an observational study including 208 acutely hospitalized older adults. Patients were stratified into 3 groups: 1) culture-negative, 2) positive for non-multidrug-resistant bacterial infections and 3) multidrug-resistant bacterial infections. Frailty was assessed using the Clinical Frailty Scale and a multidimensional frailty index. We performed multinomial logistic regression to identify independent predictors of multidrug-resistant status. Results. Of the 208 patients, 119 (57%) were culture-negative, 60 (29%) had non-multidrug-resistant infections, and 29 (14%) had multidrug-resistant infections. Age and sex distribution were similar across groups. In contrast, frailty increased progressively from culture-negative to non-multidrug-resistant to multidrug-resistant patients: median CFS was 5, 6, and 6, respectively (p = 0.004; p for trend = 0.002), and median PC-FI was 0.20, 0.24, and 0.28 (p = 0.021). The proportion of patients with a Clinical Frailty Scale > 4 rose from 56% to 70% to 83% across the 3 groups (p = 0.015). Multidrug-resistant positive patients more frequently required professional 24-hour caregivers and broad-spectrum antibiotics and had a longer length of stay compared with the other groups. Conclusions. Frailty was more strongly associated with multidrug-resistant bacterial infections than age or traditional comorbidities.
Background. Thirty-day hospital readmission is a key quality indicator in Internal Medicine. Administrative tools like the Charlson Comorbidity Index (CCI), LACE index, and Hospital Frailty Risk Score (HFRS) estimate post-discharge risk, but their performance in hospitals lacking Intermediate Care facilities remains unclear. Materials and Methods. This retrospective observational study included 851 adult patients admitted to a suburban general hospital in 2025. In-hospital deaths and elective admissions were excluded. The primary outcome was unplanned 30-day readmission. Associations between readmission and CCI, LACE, HFRS, length of stay (LOS), and discharge destination were assessed using univariate and multivariate analyses. Results. Thirty-day readmission occurred in a minority of cases. HFRS ≥ 5 was significantly associated with readmission, identifying a high-risk subgroup; no readmissions occurred among patients with HFRS < 5. Conversely, CCI, LACE score, LOS, and discharge destination showed no significant association with readmission. In multivariable analysis, frailty measured by HFRS demonstrated the strongest association with readmission risk. Conclusions. In a suburban hospital without intermediate care units, HFRS outperformed traditional comorbidity and readmission scores in predicting 30-day readmission. Frailty-based tools may better support discharge planning and risk stratification in similar healthcare settings.
Introduction. Severe community-acquired pneumonia (CAP) often causes acute respiratory failure. The right ventricle (RV) is sensitive to increases in pulmonary vascular resistance from hypoxemia, hypercapnia, and acidosis. Non-invasive respiratory support may add positive pressure and raise RV afterload. In PSI IV–V CAP, we evaluated (1) the association between oxygenation modality—non-invasive ventilation (NIV), high-flow nasal cannula (HFNC), and Venturi mask—and RV systolic function, measured by tricuspid annular plane systolic excursion (TAPSE) and lateral systolic velocity (TDI); and (2) the relationship with length of stay (LOS). Materials and Methods. Monocentric observational study in an Internal Medicine Unit. Consecutive severe CAP patients were enrolled; we excluded conditions independently altering RV load. NIV was pressure-support with PEEP; HFNC used high flow and FiO₂; Venturi masks delivered oxygen without positive pressure. Results. Seventy patients: NIV 21, HFNC 22, Venturi mask 27. RV performance differed across groups (Kruskal–Wallis p<0.001). NIV had the lowest TAPSE/TDI; the Venturi mask preserved mechanics. LOS was longer with NIV and HFNC than with a Venturi mask (p<0.001). TAPSE and TDI inversely correlated with LOS. Conclusions. In severe CAP, respiratory strategy influences RV systolic function and hospitalization. Early RV-focused echocardiography may support hemodynamically protective oxygenation choices in Internal Medicine.
Background. VEXAS syndrome is an autoinflammatory disorder caused by somatic mutations in the UBA1 gene and is characterized by severe inflammation and hematologic disorders with systemic manifestations. Cutaneous involvement is the most frequent feature and is often refractory to therapy. Case Report. We describe an otherwise healthy 60-year-old man with VEXAS syndrome presenting with systemic inflammation (fever, arthralgia, elevated inflammatory markers) and myelodysplastic syndrome. Initial treatment with high-dose glucocorticoids (2 mg/kg) was complicated by Candida parapsilosis sepsis. Following resolution of the infection after antifungal therapy, the patient developed severe cutaneous manifestations consisting of erythematous papules and plaques involving the chest, neck, face, and gluteals. Histopathological examination of a skin biopsy revealed leukocytoclastic vasculitis. Given the recent patient’s immunocompromised status, intravenous immunoglobulin (IVIg) was administered at a dose of 2 g/kg over five days while maintaining a stable glucocorticoid dosage. Treatment with IVIg resulted in marked improvement, with near-complete resolution of skin lesions after the completion of the treatment course. Conclusions. Management of VEXAS syndrome remains challenging, as no consistently effective therapies have been established. In our case, IVIg led to rapid and sustained improvement of cutaneous manifestations, suggesting that it may represent a safe and effective therapy. Further studies in larger cohorts are needed to define the role of IVIg in the treatment of VEXAS syndrome.
Introduction and Aim. Dementia is a neurocognitive disorder characterized by a progressive and chronic decline in cognitive functions. In this context, the role of the caregiver is fundamental for the management of activities of daily living (ADL) but highly exposed to a marked physical, psychological, and economic overload, defined as “caregiver burden." The present study aims to explore the burnout experienced by caregivers of individuals with dementia. Materials and Methods. A single-center cross-sectional study was conducted on 100 patients at the Dementia Clinic of the “Madonna del Soccorso” Neurology Unit of the Local Health Authority (AST) of Ascoli Piceno from March 11, 2025, to August 26, 2025, using a validated questionnaire. Results. Data shows an average age of patients diagnosed with Alzheimer's disease (70%) of 81 years, females (67%), while caregivers are women (75%) and daughters (52%) who are 60 years old. The CBI showed a high burden (>40), finding a significant correlation (Spearman) between the number of caregiver pathologies and CBI score (p = 0.017) and a highly significant correlation between patient clinical complications and CBI score (p = 0.0003). Conclusions. The study confirms a high burden, influenced both by the caregiver's state of health and the complexity of the patient's care, which falls mainly on female caregivers. Although recent legislation has provided for specific funds, it is still desirable to adopt more uniform national regulations capable of providing integrated support to the family network and the social and healthcare system.
Introduction. Splanchnic vein thrombosis (SVT) and cerebral venous thrombosis (CVT) are unusual sites of thrombosis. Cancer is a common predisposing factor and is associated with worse outcomes and increased bleeding risk. Evidence supporting the use of direct oral anticoagulants (DOACs), especially in patients with active malignancy, is limited. Materials and Methods. This single-center longitudinal observational study included adult patients with imaging-confirmed SVT or CVT treated with DOACs between January 2018 and October 2025. Inclusion was retrospective with prospective follow-up. Primary outcomes were radiological recanalization and thrombotic recurrence. Secondary outcomes included major bleeding, clinically relevant non-major bleeding (CRNMB), and all-cause mortality. Results. 43 patients were included (median age 58 years; 46.5% male), 26 with SVT and 17 with CVT; 16 had active cancer. Median follow-up was 17 months. Recanalization was assessable in 41 patients and was complete in 43.9%, partial in 29.3%, and absent in 26.8%. Active cancer was associated with a lower likelihood and longer time to recanalization. Two thrombotic recurrences (4.7%) occurred. Clinically relevant bleeding was observed in 16.3%, including 7.0% major bleeding. Seven deaths occurred, all in patients with active cancer. Conclusions. In this cohort of SVT and CVT treated with DOACs, recurrence and bleeding rates were acceptable. Active cancer identified a high-risk subgroup with reduced recanalization and increased mortality, supporting tailored management strategies.
Introduction. Heart failure (HF) is a leading cause of hospitalization in Internal Medicine and HF with preserved ejection fraction (HFpEF) accounts for approximately 50% of cases. Transthyretin cardiac amyloidosis (ATTR-CM) is an underdiagnosed cause of HFpEF with adverse prognostic implications. Although multidisciplinary care for this systemic disease is recommended, the role of the internist is frequently underestimated. Aim of the study. To evaluate the contribution of an Internal Medicine HF clinic to early diagnosis and coordination of multidisciplinary care for ATTR-CM. Methods. Descriptive observational study of the first 6 months of activity of an Internal Medicine HF clinic. Suspicion of ATTR-CM was based on integration of red flags from medical history and physical examination with internist-performed echocardiography; a targeted amyloidosis workup was then initiated (monoclonal protein screen and bone-tracer cardiac scintigraphy). Results. Twenty-five patients were evaluated (EF: 11 preserved, 9 mildly reduced, 5 reduced). Two ATTR-CM diagnoses were made (8%), both in HFpEF (2/11; 18%) with extracardiac red flags (bilateral carpal tunnel syndrome) and suggestive echocardiography (left ventricular wall thickening, diastolic dysfunction). Emblematic case: an 80-year-old woman discharged from the Emergency Department with an echocardiographic diagnosis of hypertensive heart disease. Conclusions. ATTR-CM is not an exceptional diagnosis in HFpEF (prevalence up to 11% in selected populations) and an internist-led HF clinic can serve as a key hub for early detection and coordination of multidisciplinary care.
Introduction. Tumour-induced osteomalacia (TIO) is due to an overproduction of fibroblast growth factor 23 (FGF23) by mesenchymal tumours, causing hypophosphatemia, osteomalacia, and muscle weakness. TIO is cured by tumour resection, but neoplasms may be unidentifiable/ unresectable or the patient may refuse surgery. Description. We reported the case of a 64-year-old female with multiple non-traumatic fractures, low bone mineral density, pain, and reduced independence in activities of daily living. Biochemical evaluation showed hypophosphatemia, high alkaline phosphatase/C-terminal telopeptide, slightly high parathyroid hormone and normal albumin-corrected total calcium/vitamin D. Tubular phosphate reabsorption was slow (80%), whereas FGF23 was elevated. A ⁶⁸Ga-DOTATOC PET identified a lesion in the skull, compatible with a 27×18×28 mm meningioma. Total body computed tomography and cerebral magnetic resonance confirmed the meningioma. The neurosurgeon excluded intracranial surgery/biopsy, so medical treatment with oral phosphate and calcitriol was started, resulting in improvement in pain severity/fatigue and phosphate normalization. Neither adverse events nor tumour progression occurred during follow-up. Conclusions. Meningioma was identified as the cause of TIO, although there is limited knowledge about meningiomas causing TIO. This is the third case reported of TIO induced by an intracranial meningioma. However, an intracranial mass may hide a low-grade phosphaturic mesenchymal tumor, mixed connective tissue variant (PMTMCT).
Background. Researchers have limited evidence on antiarrhythmic drug (AAD) use in very elderly patients with atrial fibrillation (AF). We investigated clinical characteristics and outcomes associated with AAD use in this population. Materials and Methods. 4,244 very elderly (age ≥80 years) AF patients from the nationwide START registry were included. Patients were divided into 3 groups: no AADs (n=3,573), class 1c-AAD (n=207), and amiodarone (n=464). Risks of all-cause mortality and cardiovascular events (CVEs) were analyzed according to AAD. Results. The mean age was 84.8±3.8 years; 54.9% were women. AADs were used in 15.8% of patients. The use of Class 1c-AADs was directly associated with paroxysmal AF and inversely associated with older age, female sex, diabetes, heart failure, digoxin, COPD/OSAS, beta-blockers, and lack of familial/social support. Amiodarone use was directly associated with paroxysmal AF, coronary artery disease, and wheelchair use and inversely associated with age, peripheral artery disease, living alone, digoxin use, beta-blockers, and lack of familial/social support. Over a mean follow-up of 685.6±537.7 days, 492 all-cause deaths and 548 CVE events occurred. In univariable Cox analysis, Class 1c AADs were associated with lower mortality (HR 0.371, 95% CI 0.191-0.717) and CVEs (sHR 0.443, 95% CI 0.250-0.786), while amiodarone was not. These associations did not persist in multivariable analysis. Conclusions. Among very elderly AF patients, the choice of rhythm control strategy is influenced by frailty elements. AADs use was not associated with better survival.
